Study Shows Small Hospitals Safer, Cheaper for Some Procedures

A new study finds that certain surgical procedures at small critical access hospitals turn out significantly better than they do at their urban counterparts. The report offers some good news after several years of closures of critical access hospitals in rural America.

Share This:

On the heels of a report warning that more than a third of the nation’s critical access hospitals are in danger of closure comes some encouraging news. A new study indicates certain procedures are being performed in these small hospitals more safely and at a lower cost than in larger institutions.

A University of Michigan team of researchers looked at four common surgeries – appendectomy, gall bladder removal, hernia repair and removal of all or part of the colon – and found no statistically significant difference in 30-day mortality rates between critical access and other hospitals.

Further, critical access hospitals experienced serious complications in performing these procedures 6.4 percent of the time as compared with 13.9 percent of the time in other hospitals.

Critical access hospitals also billed Medicare an average of $1,400 less for the procedures.

Critical access hospitals serve many of the nation’s remotest regions. By definition, they have fewer than 25 beds and are more than 35 miles from the next nearest hospital. They must maintain an average length of stay of 96 hours or less for acute-care patients and provide 24-hour emergency-care services. In return, they receive preferential reimbursement from Medicare, which covers more of their costs.

The Sheps Center at UNC maintains a database of critical access hospitals that have closed since 2010. Click on the map icons to see information on specific closures, or see the complete list at the Sheps Center website.

Doing What They ShouldThe Michigan researchers examined more than 1.6 million Medicare-beneficiary admissions to 828 critical access hospitals and 3,676 other hospitals. Their results were published May 17 in the Journal of the American Medical Association.

The researchers found that patients who had any of the four types of operations at critical access hospitals tended to be healthier upon admission than patients treated for the same procedures at other hospitals. They said this indicated critical access hospital surgeons appropriately selected patients who they felt would be most likely to have positive outcomes, while sending higher-risk patients to larger hospitals.

“From a surgical standpoint, these hospitals appear to be doing exactly what we would want them to be doing: common operations on appropriately selected patients who are safe to stay locally for their care,” lead author Andrew Ibrahim said in a release.

Transylvania Regional Hospital. Photo by John Warner

That said, even after correcting for differences in health status at the time of the operations, the critical access hospitals had equal or better outcomes.

‘On the Firing Line’In rural communities throughout the country, small hospitals in general, and critical access hospitals in particular, are facing mounting challenges including reduced reimbursements; aging and declining populations; and difficulties recruiting health care professionals.

“Critical access hospitals are on the firing line. They’re in the middle of the target,” Alvin Hoover, past chairman of the American Hospital Association’s Small or Rural Governing Council and current board chair of the Mississippi Hospital Association, said in a recent interview. “It’s hard for me to understand why you want to target those guys, because if you look at the cost of care, they do it cheaper than anybody else.

“If you can keep that person home, right there in that local community, your cost of treatment of that pneumonia patient, [for example], is going to be way less than it is if you have to send them to the big university.”

The results found in this research, the study’s authors write, should “inform legislators about the valuable role critical access hospitals provide in the U.S. health care system.”